Having a Conceptual Idea of Curing Tinnitus

The idea is simple but the technology is not there yet...

In short: My tinnitus cure concept is to remove affected "outer hair cells" from inside your cochlea.

Look at the below image for what is inside the scala media of the cochlea:




Long version:

1. Mapping affected outer hair cells:

Of course we need a camera to map the affected outer hair cells, now the smallest camera available is still too big, 500um (0.5mm), we need even smaller like 100um (0.1mm). Theoretically such a camera will be released in 2-6 years because technology tends to advance linearly, 2 fold in 2 years, so this camera 500um was created in 2019, meaning somewhere in 2021-2022 we will have a 250um camera and in 2023-2024 125um.

The camera will be inserted inside the cochlea, inside the scala media.
Cochlea is like a pea... very small.

Camera will be built inside a special tool (robotized most likely), which will be controlled by a doctor.

The special tool will have a very very small "cutter" that will be used later to cut/remove damaged outer hair cells...

To do this a hole will be made in the tympanic membrane and then in the cochlea.

The hole will be made in such a way that it will grant access for the camera to the scala media inside the cochlea.

The camera will be used to map where and how many damaged outer hair cells we have.

2. Removing affected outer hair cells:

Now the other hard part will be removing the damaged outer hair cells...

The special tool that we have the camera on, the "cutter" will gently cut them all together (only where we have damaged outer hair cells that do not function correctly) and then remove them outside...

Most likely such a treatment will happen only for higher pitch ringing... I think this will not help lower pitch ringing because cochlea is round like a "snail house".

The patient's hearing will be negatively affected by 1% - 5% but in exchange of that the ringing should stop (theoretically).

At the end I want to say that you can criticize (or even laugh) if you don't like the idea, I accept every thought, or if you like you can share additional thoughts and ask me anything (I am not a doctor or a researcher, I just want my tinnitus go away...)

If somebody wants to help make a video with 3D animation or just 2D animation I would be very happy, you can contact me via DM...

 

Why do you think that will cure Tinnitus?

 

The fundamental concept to your idea is, at our current understanding, is not entirely correct. The assumption is that "damaged" out hair cell removal will eliminate tinnitus. In other words, these "damaged" out hair cells are continuously activated to send auditory signals and so removing them will stop tinnitus signals.

If this is the case, then extrapolating this idea would mean cutting the cochlear (auditory) nerve will entirely stop all sounds, including tinnitus. However, this is not the case. Studies have shown that sectioning the cochlear nerve does work for some (human) patients but also DO NOT work for some patients. Animal studies on measuring the tinnitus activity on the auditory cortex also show that cutting the cochlear nerve does not eliminate tinnitus stemming from noise induced damage.

Your should be tested, at least on animals. Perhaps there are malfunctioning cochlear hair cells permanently being activated (or deactivated) that is producing tinnitus. Animal studies that can selectively remove these damaged cochlear hair cells can prove/disprove your hypothesis vs the current understanding that tinnitus is due to auditory inhibition with neural-plasticity.

However, from what I gathered reading here that just drilling a hole into the cochlea introduces massive and permanent damage to healthy cochlear hair cells. It's not a issue of camera resolution. It's an issue on how to minimally get into the cochlea without massive damage.

So the issue is how to perform your idea without massive destruction in the first place, which at the moment is impossible even with animals.

 

This is interesting but could potentially be risky... what if removing outer hair cells results in worsened hyperacusis since one of the leading theories is that damaged/dead outer hair cells and their supporting cells leak ATP onto the type 2 nerve fibers resulting in pain. Tinnitus is not necessarily due to damage to the OHCs either, it could be IHCs or synapses. I think this is a compelling idea but this kind of bioengineering seems extremely complex and intricate to me - I think regenerative approaches are far more realistic and feasible for the near-term.

 

"A common cause of tinnitus is inner ear hair cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can "leak" random electrical impulses to your brain, causing tinnitus."

source: https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156

So by removing damaged ones = no more impulses to the brain so no more tinnitus?

 

There is another theory on which regenerative medicines for tinnitus are based on. The damaged, bent hair cells can't give outside input to the brain, so the brain generates the tinnitus sounds as a compensation for lost auditory input. Regenerative medicines like FX-322 are supposed to regrow these hair cells, hearing gets better and as a side effect, hopefully, the brain will stop blessing us with tinnitus.

 

I'm not really sure how this would work - causing further hearing loss would, if anything, increase the brain's response to a lack of input resulting in tinnitus surely? I don't think causing further loss in the answer tbh, I think increasing input via regeneration is.

 

Ok, so I was referring to "Microvilli" or "Hair Bundle" as outer hair cells... I should have researched more before creating the concept.



So I just want to point out that my idea is to remove the damaged Microvilli, like in the image.

I think people with hearing loss have lost some of these Microvilli (do they hear anything?)

People who have tinnitus I think are those with damaged Microvilli, right?

 

I think the prevalent theories focus on the fact that the damaged hair cells are just not providing signals, rather than providing erratic signals. If it were the latter, perhaps your idea would work, but the current working models seem to indicate that the former is what is actually happening.

 

Tinnitus and hearing loss can arise from loss of OHCs, IHCs, and synapses so essentially anywhere in the cochlea that you can loose input can result in tinnitus.

 

I think no one can say for sure what is what... could be true but I tend to believe that damaged hair cells (Microvilli) are most likely the problem... testing on animals is a must, but animals can not speak, so I think it is required in the future to test on humans as well, so we can answer more questions... if it will not work, then I am wrong...

 

I always though that. How the f*ck does one know when an animal is tinnitissing...

Talk about pseudo science...

 

I've read somewhere that they are given medication which is known to cause ototoxicity and tinnitus (for example salicylates) , then from their behavior researchers deduce that they have tinnitus.

 

How?

 

Tinnitus is like "phantom limb" of the ear. You don't cure phantom limb with more amputation.

People who have very profound hearing loss have no outer hair cells left (they are left with flat epithelia which has no hair cell structure) and still have tinnitus.

 

I think tinnitus is like a problematic tooth! So instead of pain you get this strange sound...

You cure your tooth pain by removing it, the same idea comes to me for getting rid of tinnitus.

Just my thoughts, I am not a doctor or expert...

 

Current studies say it doesn't work like that.
If you cut the auditory nerve, you still have tinnitus.

 

How do you know? I am asking because I want to know more, do you have any sources?

 

But if tinnitus is the result of a lack of cochlear input, as it's hypothesised to be, then why would further decreasing input resolve it? That doesn't make sense. It's a consequence of hearing loss - you don't cure hearing loss... by causing more hearing loss. Many people with various degrees of hearing loss, from the most severe to mild, suffer from tinnitus along with their hearing loss.

 

Still sounds fishy IMO. Research snake oil...

 

Here is one on nerve section and tinnitus:

"Of 68 patients undergoing translabyrinthine eighth nerve section, 60 (80%) had tinnitus preoperatively. Improvement occurred in 45%, while 55% reported the condition to be the same or worse"

Https://pubmed.ncbi.nlm.nih.gov/6915835

This study was in 1981 but the current thinking among researchers is that tinnitus is very akin to phantom limb.

It's interesting that some improvement happened in 45% of people though but the above study was only in people who had a tumor compressing on their nerve (which I guess in some people is worse for tinnitus than no nerve at all).

To use an example In people with cochlear causes of tinnitus: as people with very profound hearing loss lose hair cells to become cuboidal cells and then flat cells with no hair cell structure (like a scar, the hair cells are completely gone in this case), their tinnitus does not improve and in many cases gets worse.

 

This is the method they use. It's not perfect but it's a really smart work around imo.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411996/

 

This is my current belief as well. I've written to VS Ramachandran and various other experts at his university department about this but unfortunately never received a reply. Would love to hear their perspective.

 

Did you see the photo of the new hair cells, they looked funky compared to the original hair cells. I wonder if they can eliminate the problem?